Washington Report: The e-Bandwagon

Everyone is jumping on the electronic prescribing bandwagon. The federal government is driving e-Rx adoption by establishing standards that Medicare drug plans will have to adopt by 2009, and HHS officials are pushing to make this happen much earlier.

Pharma companies are joining the chorus, despite fears that e-Rx software will be configured to make it difficult for doctors to access information about non-formulary and alternative products, and will promote preferred drugs based on price.

End of an Error?

All pharma wants is a "level playing field in e-prescribing," says Michael Weinberger of Johnson & Johnson's eJNJ subsidiary. Companies believe they can compete effectively in an electronic prescribing environment if information systems permit full disclosure and allow doctors to create bookmarks and "favorites" lists that link easily to information they want.

The bottom line for industry is that prescribing decisions should be left in the hands of doctors and patients, Weinberger explained at a May conference on e-prescribing sponsored by Health Strategies Consultancy.

Marketers support systems that provide physicians with information at the point of care on all prescribing options, as well as formulary listings, co-pays, and patient costs. If a physician prefers a drug that costs $100 a month, the doctor then has an opportunity to tell the patient why he thinks that medicine is worth it and explain the drawbacks of cheaper alternatives. Such information reduces unpleasant surprises at the pharmacy counter that often lead to complaints or noncompliance.

Complex pre-authorization procedures and step-therapy requirements, alternatively, would make it difficult to prescribe non-preferred drugs. Manufacturers recognize that electronic prescribing systems will boost generic drug utilization; what they want is for doctors and patients to be informed if a prescribing system makes an automatic generic substitution.

Pushing Patient Compliance
One point of debate is whether e-prescribing will boost prescribers' compliance with formularies. Studies are inconclusive, noted Weinberger. Pharmacy benefit managers (PBMs) report that they already get 90 percent compliance to some formularies and don't expect to do much better. Increased generic prescribing is more likely, and PBMs say that even a one-to-three percent rise in generic drug utilization can cut costs significantly.

The biggest potential benefit is that e-prescribing systems may improve patient compliance with a prescribed course of treatment. With electronically transmitted prescriptions, pharmacists can inform the plan or prescriber if a patient is a "no-show." A PBM can follow up and steer the individual into disease management or other compliance programs. Drug companies are analyzing how much e-prescribing will prompt consumers to show up at the pharmacy to get their prescriptions and refills.

Seeking Safe Harbors
For e-prescribing to succeed, physicians have to buy into it. Health plans, PBMs, and state and local e-prescribing consortia are willing to provide free hardware and software to physicians, and some are even paying doctors to go electronic. But many organizations are holding off on giveaways for fear of violating federal anti-kickback laws.

Under current policies, it is illegal for payers, hospitals, insurers, and pharma companies to give physicians anything of value that might induce referrals or purchases. The Medicare legislation calls for the HHS inspector general to define a clear safe harbor from anti-kickback laws specifically to allow these parties to give IT equipment and services to doctors.

Drug manufacturers are not on the safe-harbor list, and identifying a clear pathway for pharma companies to provide e-prescribing support to prescribers may be tricky. But Medicare officials support such efforts, provided they maintain current fraud and abuse protections. Legal experts believe that a narrowly defined safe harbor is possible so long as prescribing systems do not favor any particular drug or company.